Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip<sup>,</sup>

Denadai, Rafael; Sabbag, Anelise; Amaral, Cassio Eduardo Raposo; Pereira Filho, João Carlos; Nagae, Mirian Hideko; Amaral, Cesar Augusto Raposo

doi:10.1016/j.bjorl.2017.08.006

Acessibilidade / Reportar erro

Brasil

Brazilian Journal of Otorhinolaryngology

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original articles • Braz. j. otorhinolaryngol. 84 (6) • Nov-Dec 2018 • https://doi.org/10.1016/j.bjorl.2017.08.006 copy

Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip^☆ ☆ Please cite this article as: Denadai R, Sabbag A, Amaral CE, Pereira Filho JC, Nagae MH, Amaral CA. Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip. Braz J Otorhinolaryngol. 2018;84:697-707. ^,^☆☆ ☆☆ Study carried out at Instituto de Cirurgia Plástica Craniofacial, Hospital SOBRAPAR, Campinas, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up.

Objective:

To evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency.

Methods:

Patients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p < 0.05).

Results:

Thirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5 ± 0.7) was significantly (p < 0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8 ± 0.4 and 1.7 ± 0.9, respectively).

Conclusion:

The buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.

KEYWORDS
Cleft palate; Velopharyngeal insufficiency; Hypernasality; Buccinator myomucosal flap

Characteristics	Patients (n = 37)	p-Value
Age (years) M ± SD	20.8 ± 12.4 (5-41)	-
Female/male n (%)	16 (43.2)/21 (56.8)	>0.05
Spina classification n (%)
Incomplete post-foramen incisor cleft	2 (5.4)	<0.01
Complete post-foramen incisor cleft	10 (27)
Unilateral incisor transforaminal cleft	14 (37.8)
Bilateral incisor transforaminal cleft	11 (29.7)
Origin of patients, n (%)
Treated initially in our service	20 (54.1)	>0.05
Treated initially in other services	17 (45.9)	>0.05
Primary palatoplasty ^a a Two-stage palatoplasty using the Goteborg technique (n = 14, 37.8%) and single-stage palatoplasty using Von Langenbeck, Veau, and Ward-Kilner techniques, with or without intravelar veloplasty (n = 23, 62.2%). n (%)
Recent (≤18 months)/late (>18 months)	19 (51.4)/18 (48.6)	>0.05
Previous surgical treatment, n (%)
Palatine fistula (yes/no)	26 (70.3)/11 (29.7)	<0.01
Velopharyngeal insufficiency (yes^b b All patients had failed prior surgical treatment (pushback palatoplasty, radical dissection of the palatine veil musculature, or double reverse z-plasty). /no)	23 (62.2)/14 (37.8)	<0.03
Flap width (millimeters) M ± SD	15.5 ± 4.2	-
Surgical complications, n (%)
Yes/no	11 (29.7)/26 (70.3)	<0.01

Characteristics	Preoperative	Postoperative
		Recent (3 months)	Late (12 months)	p-Value^a a Inter-period comparisons.
STOP-Bang questionnaire M ± SD	0.73 ± 0.45	0.78 ± 0.42	0.73 ± 0.45	>0.05
Low risk, n (%)	37 (100)	37 (100)	37 (100)	>0.05
Intermediate risk, n (%)	0 (0)	0 (0)	0 (0)
High risk, n (%)	0 (0)	0 (0)	0 (0)
Epworth sleepiness scale M ± SD	3.59 ± 1.79	3.62 ± 1.66	3.57 ± 1.68	>0.05
Low risk, n (%)	37 (100)	37 (100)	37 (100)	>0.05
High risk, n (%)	0 (0)	0 (0)	0 (0)	>0.05

Characteristics of the velopharyngeal gap	Preoperative	p-Value^a a Intra-period comparisons.	Postoperative				p-Value^b b Inter-period comparisons.
			Recent (3 months)	p-Value^a a Intra-period comparisons.	Late (12 months)	p-Value^a a Intra-period comparisons.
Gap pattern n (%)							<0.01
Absent	0 (0)	<0.03	5 (13.5)	<0.01	21 (56.8)	<0.01
Coronal	11 (29.7)		13 (35.1)		6 (16.2)
Circular	15 (40.5)		13 (35.1)		7 (18.9)
Circular with Passavant fold	11 (29.7)		6 (16.2)		3 (8.1)
Sagittal	0 (0)		0 (0)		0 (0)
Gap size n (%)							<0.01
Complete velopharyngeal closure	0 (0)	<0.02	5 (13.5)	<0.01	21 (56.8)	<0.01
Punctiform	0 (0)		2 (5.4)		9 (24.3)
Small	0 (0)		13 (35.1)		7 (18.9)
Medium	10 (27)		12 (32.4)		0 (0)
Large	27 (73)		5 (13.5)		0 (0)

Characteristics	Preoperative	p-Value^a a Intra-period comparisons.	Postoperative				p-Value^b b Inter-period comparisons. Note: The degree of agreement between the evaluators was considered excellent (kappa values ≥ 0.89) in all measurements.
			Recent (3 months)	p-Value^a a Intra-period comparisons.	Late (12 months)	p-Value^a a Intra-period comparisons.
Hypernasality n (%)
Improvement (yes/no)	-	-	28 (75.7)/9 (24.3)	<0.01	37 (100)/0 (0)	<0.01	<0.01
None	0 (0)	<0.01	4 (10.8)	<0.01	22 (59.5)	<0.01	<0.01
Mild	0 (0)		10 (27)		11 (29.7)
Moderate	6 (16.2)		17 (45.9)		4 (10.8)
Severe	31 (83.8)		6 (16.2)		0 (0)

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Corresponding author. E-mail:cesaraugustoraposo@hotmail.com (C.A. Amaral).